I'm meeting with my surgeon this Friday. I have very small breasts (not even an A cup) and am quite thin. I am deciding between DIEP and implants with TE. My preference is DIEP, but there are concerns I don't have enough fat. I think it's unusual to do a DIEP recon and end up with less than an A cup, but as that's what I've had all my life, I'm fine looking just as I do now. (I will also go as small as possible if I go with the implants.)

I've switched to a surgeon who does both, so I'm interested to hear what she has to say on Friday. I'll follow up and let you know...

What are your reasons for choosing the DIEP procedure over an implant? Since you are so thin, do you have enough tummy tisue to do a DIEP? Did you or are you having a unilateral or bilateral mastectomy?

I had a unilateral mastectomy and chose an implant over the DIEP. After much thought I decided I would save the DIEP in case I ever had to have my other breast removed. Over the years I have had several biopsies on my "good" side. Tissue can only be removed from the tummy area once. What tissue is not used is discarded. The DIEP is a very long procedure taking 6-8 hours if all goes smoothly & would require longer hospitalization. With the DIEP I would have had 2 major incisions to heal.

You might ask the new PS if she thinks you will have enough tissue to create the size you want. It is not just the tissue that protrudes on the surface to create a new breast but what is needed to fill your chest cavity. Sometimes the cavity tips inward creating the need for more replacement tissue.

You might also ask that since you are so small breasted and need so little replacement tissue, do the risks of the DIEP outwiegh the results? Remember that no procedure is without possible problems.

With implant reconstruction, the PS generally takes several sizes & profiles of implants into the surgery and can make size & profile adjustments as need.

I have a small B cup and had unilateral stacked-DIEP 3 years ago. I would have done it for an A cup, as well. Like you, I wasn't interested in being bigger, just being the same as I was before cancer. I was also thin and was told by the DIEP surgeon here that I didn't have enough fat to construct a breast. I did lots of research - reading and online. I found a clinic in New Orleans that does the "stacked" DIEP. They pioneered the procedure and are the only surgeons who do it. They use both sides of the abdominal area, stacking one side on top of the other, rather than discarding half, which is what a surgeon who doesn't know how to do this procedure would do. They specifically created this procedure for women such as us - those who are thin and don't have a lot of extra body fat.

It doesn't matter how small or big your breast is in deciding which procedure you want. I disagree with the poster above, on two levels. One is that it is not clear that any one procedure - implants vs. DIEP - is riskier than another. Both involve surgery, probably at least two, unless you are having a skin-sparing mastectomy. That will give you the best result. If you have already had your mastectomy, then with DIEP you will not have to go through the expansion process -, as you would with an implant - which can be pretty grueling. Also, there is always the risk of capsular contraction with an implant, as well as the need to have it replaced at some time down the road - meaning another surgery.

The second point I take issue with is that, somehow, having a smaller breast to replace makes DIEP not worth it. The benefits from using your own tissue - which you've no doubt already researched - are the same whether your breasts are large or small. The size of your breasts shouldn't impact your decision at all, in my opinion.

I don't think it is unusual to do DIEP for an A cup. I know that my surgeon has done them. You can look on the clinic's website photos at all the different sizes of women (and breasts) who have benefitted from DIEP recon.

Good luck in making your decision about which procedure you want. But be sure to spend just as much time (or more) on deciding which surgeon you're going to use. DIEP surgery requires a great deal of skill, which can only be obtained through lots and lots of experience. That will greatly affect your outcome. I'm going to paste two links here, that I hope might be helpful. One is the link to the clinic I chose, and the other is a video thing that I was part of for BC awareness month - there were 31 women's stories, one for each day of October. I agreed to do it if I could make reconstruction my "issue." I feel very passionate about women knowing all their options and not being limited by what the surgeons in their area tell them. Go for the best! If you have any other questions you want to ask, please don't hesitate.

mawhinney - Thank you for your thoughts. I've researched the pros/cons of both quite thoroughly, and for many reasons (prior radiation and very small size being chief among them) I would prefer DIEP if possible. I realize it's unusual, many women want bigger breasts, or feel like if they have to go through this they would at least like to get bigger breasts out of the deal. I am very happy with my small size though, and frankly, having larger breasts would be very difficult for me to get used to! (To give you an idea, I buy special "Nearly A" bras, and need to insert the "chicken cutlets" for them to fit without gapping.) I have canceled my initial surgery with a PS who told me I couldn't do DIEP, only implants for my bilat mast. (He only does implants.) I've had a consult with the new surgeon's PA, and she felt that although I am quite thin, there would be enough tissue to create 2 very small breasts, possibly even smaller than I am now. (That part is hard to imagine! LOL) The good news is this surgeon does both implants and DIEP, so I'll feel confident that if she says implants are the way to go, it's not because it's the only option she has.

Minn - thanks for your input as well (and for championing my desire to stay for all intents and purposes flat chested! LOL) So far I feel very comfortable with the new surgeon's practice, and I suspect I'll like her as well when I meet her on Friday. She comes highly recommended, but is newer to DIEP than another very well-respected DIEP surgeon in my area (she trainined under him I believe, but I will confirm this on Friday.) I will ask her the hard questions on Friday, particularly if she has successfully done a DIEP reconstruction to such a small size, and then make a decision.

I had a DIEP in May and revision about 2 weeks ago. I'm a small B. I chose DIEP in part because I had radiation. The success rate for an implant in radiated breasts is only about 50% and there can be problems with contracture, and they will eventually need replacement. If you are having a MX with immediate reconstruction, you won't need to go through the tissue expansion process. However, if it's a delayed DIEP, you probably will. They need the skin for a DIEP just as much as they do for an implant. The good news is that if you're small breasted, they won't need to put in as much and you'll be expanded sooner. You can PM TimTam and get directions for how to get on her picture site, and there are pictures of small breasted women who've had DIEP. They look great! You can also search the web by Googling "DIEP picture reconstruction" and you should be able to find some plastic surgeons sites with pictures. Don't look for the exact phrase, look for all the words.

Just want to make a correction. It is not necessary to undergo tissue expansion with delayed DIEP. If there is a need for more skin than has been left by a prior mastectomy, they transplant the entire flap, including the needed skin.